A variety of medical devices for delivering a therapy and/or monitoring a physiological condition have been used clinically or proposed for clinical use in patients. Examples include medical devices that deliver therapy to and/or monitor conditions associated with the heart, muscle, nerve, brain, stomach or other organs or tissue. Some therapies include the delivery of electrical signals, e.g., stimulation, to such organs or tissues. Some medical devices may employ one or more elongated electrical leads carrying electrodes for the delivery of therapeutic electrical signals to such organs or tissues, electrodes for sensing intrinsic electrical signals within the patient, which may be generated by such organs or tissue, and/or other sensors for sensing physiological parameters of a patient. Some medical devices may be “leadless” and include one or more electrodes on an outer housing of the medical device to deliver therapeutic electrical signals to organs or tissues and/or sense intrinsic electrical signals or physiological parameters of a patient.
Implantable cardiac pacemakers or cardioverter-defibrillators, for example, provide therapeutic electrical signals to the heart, e.g., via electrodes carried by one or more medical leads or via electrodes on an outer housing of a leadless implantable medical device. The therapeutic electrical signals may include pulses for pacing, or shocks for cardioversion or defibrillation. In some cases, a medical device may sense intrinsic depolarizations of the heart, and control delivery of therapeutic signals to the heart based on the sensed depolarizations. Upon detection of an abnormal rhythm, such as bradycardia, tachycardia or fibrillation, an appropriate therapeutic electrical signal or signals may be delivered to restore or maintain a more normal rhythm. For example, in some cases, an implantable medical device may deliver pacing stimulation to the heart of the patient upon detecting tachycardia or bradycardia, and deliver cardioversion or defibrillation shocks to the heart upon detecting fibrillation.
Numerous of the functions of the implantable medical device are controlled as a function of a local system clock that is included within the implantable medical device. The local clock may include an oscillator that generates an oscillator signal that causes the counter to increment its count. For example, an oscillator signal having a frequency of one megahertz may cause a counter to increment its count every microsecond, i.e. to count microseconds. Higher frequency oscillators may be used to provide higher time resolutions. A local time may be associated with a counter by incrementing the counter with a value other than one. For example an oscillator having a frequency of 250 kHz may be used to increment a counter by four every four microseconds in order to maintain a time count in microseconds. A value by which a counter is incremented depends on the rate of its oscillator compared to a time increment to be counted.
The implantable medical devices are also preferred to have a small housing form factor to enable an unobtrusive implantation within a patient. In the case of leadless implantable medical devices, the housing form factor must be extremely small to enable implantation within or adjacent to organs or tissue. For example, a leadless pacemaker may be implanted directly into a ventricle of the heart. The battery consumption is always a concern when designing implantable medical devices, but this concern is increased for small form factor devices that can only accommodate a small battery canister. A competing design requirement for implantable medical devices is high accuracy clocking signals. High clocking accuracy is needed to ensure accurate sensing and delivery of therapeutic electrical signals. However, generating the high accuracy clocking signals consume a substantial amount of current. On the other hand, the frequency of oscillators associated with low-power clocks changes over time due to poor long-term stability, temperature characteristics, and/or other environmental factors. Therefore, a need remains for clocks that consume little power yet having improved accuracy.